HIV

Question 1

How to diagnose acute infection in the window period

Answer 1

HIV viral load or viral antigen

Viral load >50,000 is diagnostic in window period

Question 2

Diagnoses that warrant HIV testing

Answer 2

• severe or treatment-refractory HSV infection
• oral thrush or esophageal candidiasis
• P. Jirovecii pneumonitis
• cryptococcal meningitis
• disseminated mycobacterial infection
• CMV retinitis or GI disease
• toxoplasmosis
• severe seborrheic dermatitis or new/severe psoriasis
• recurrent herpes zoster infections

Question 3

How is AIDS diagnosed

Answer 3

• HIV positive

- CD4

Question 4

Symptoms of acute HIV infection

Answer 4

Febrile illness within several weeks of a potential exposure

• fatigue
• lymphadenopathy
• pharyngitis
• rash
• headache

Question 5

When to initiate ART therapy

Answer 5

Accidental needle-stick exposure

CD4 count

Question 6

Standard ART treatment regimen

Answer 6

2 nucleoside reverse transcriptase inhibitors(tenofovir, emtricitabine)
1 non-nucleoside reverse transcriptase inhibitor

Question 7

Alternative ART regimen

Answer 7

2 nucleoside reverse transcriptase inhibitors
1 protease or integrase inhibitor(raltegravir)
Protease inhibitors are given with a small dose of ritonavir which is used as a booster

Question 8

How does Immune reconstitution inflammatory syndrome(IRIS) occur?

Answer 8

A pre-existing sub clinical infection is unmasked by immune system recovery
A previously treated infection may paradoxically recur because of the presence of persistent antigens

Question 9

NRTI common side effects

Answer 9

Zidovudine-anemia, neutropenia, myopathy
Didanosine-peripheral neuropathy, pancreatitis
Stavudine-peripheral neuropathy, lactic acidosis, fat atrophy
Abacavir-hypersensitivity reaction

Question 10

NNRTI common side effects

Answer 10

Nevirapine-rash(Stevens johnson), hepatotoxicity
Efavirenz-mood or pyschiatric alterations, vivid dreams, hallucinations, contra-indicated in pregnancy
Tenofovir-kidney dysfunction

Question 11

Protease inhibitor side effects

Answer 11

Sequinavir, ritonivir, nelfinavir, tipranavir-HLD, pancreatitis, insulin resistance
Indinavir-kidney stones, kidney dysfunction, elevated t bili, HLD, pancreatitis, insulin resistance
Atazanavir-elevated t bili and same as first set

Question 12

Prophylaxis in HIV

Answer 12

CD45mm
Flu-annual vaccine, no live vaccines
Pneumococcal pneumonia-vaccine every 5-10 yrs
Hep A&B-one time vaccine

Question 13

Treatment for toxoplasmosis

Answer 13

Sulfazadine-
Pyrimethamine-
Folic acid-